Routine Regimen Research Articles

Venous thromboembolism after esophagectomy for cancer: a systematic review of the literature to evaluate incidence, risk factors, and prophylaxis.

Although esophagectomy remains the preferred treatment for esophageal cancer, it is still associated with a number of complications, including post-operative venous thromboembolism (VTE). The aim of this study was to summarize the reported incidence of VTE after esophagectomy, its risk factors, and prevention strategies. We conducted a systematic search of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen studies met our inclusion criteria and were selected in the present review. Overall, we identified 9768 patients who underwent esophagectomy, with a post-operative VTE rate of 4% (440 patients). The reported risk factors for VTE included advanced age, American Society of Anesthesiologists (ASA) class III or IV, a history of cardiovascular or pulmonary disease, and the implementation of preoperative chemo-radiotherapy. Postoperative acute respiratory distress syndrome was also associated with VTE. No universally applied prevention strategies for VTE after esophagectomy were identified in the literature. Despite advances in perioperative care, VTE after esophagectomy still represents a source of morbidity for about 4% of patients. Low molecular weight heparin is suggested as the routine standard prophylactic regimen after esophageal cancer surgery.

Controlled ovarian hyperstimulation for poor ovarian responders undergoing in vitro fertilisation/intracytoplasmic sperm injection: a protocol for systematic review and Bayesian network meta-analysis

IntroductionControlled ovarian hyperstimulation (COH) is the routine regimen used to generate a sufficient number of follicles during in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Poor ovarian response...

Basiliximab Induction with Delayed Calcineurin Inhibitors for High-Risk Lung Transplant Candidates.

PurposeCalcineurin inhibitor (CNI) use has improved lung transplantation outcomes. However, significant perioperative complications in patients receiving CNI can deteriorate the early course of lung transplantation. To date, there is no consensus regarding the optimal agent for the induction regimen after lung transplantation. We aimed to determine the efficacy of basiliximab induction with delayed CNI initiation in the prevention of acute complications without compromising immunosuppression in high-risk patients.Materials and MethodsBetween January 2013 and December 2019, 236 patients at a single lung transplant center were retrospectively reviewed. Forty-one patients (17.4%) received basiliximab induction, and 195 patients (82.6%) received a routine triple-drug regimen without induction. The primary endpoint was postoperative acute kidney injury with several other postoperative outcomes as secondary end-points.ResultsPreoperatively, the induction group had a higher proportion of patients who were admitted before transplantation (95.1% vs. 47.7%, p<0.001) and received intensive unit care (90.2% vs. 33.8%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (87.8% vs. 20.0%, p<0.001) compared to the non-induction group. No significant differences were observed in the incidence of acute rejection between groups (p=0.657), although lower incidence of postoperative complications, including acute kidney injuries or culture-proven infections, were observed in the induction group. However, the differences were not statistically significant. A subgroup analysis of high-risk and preoperative ECMO support groups showed similar results.ConclusionBasiliximab induction with delayed CNI initiation for high-risk patients might decrease the incidence of perioperative complications, including acute renal failure, without increasing the risk of acute rejection.

Impact of Pediatric COVID-19 on Family Health-Related Quality of Life: A Qualitative Study from Latvia.

Information on family health-related quality of life (FHRQoL) among families of children with the coronavirus disease 2019 (COVID-19) is limited. This qualitative study explores the impact of pediatric COVID-19 on FHRQoL from the parents’ perspective. Semi-structured interviews were conducted with parents (n = 20) whose children had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Inductive thematic analysis revealed the following 10 themes that represented parents’ perception of FHRQoL while taking care of a child with COVID-19: pediatric COVID-19 as a disease with many unknowns; emotional saturation; internal family relationships in the context of “a new experience”; routine household activities and daily regimen while family is in lockdown; plenty of free time; a wide social support network; social stigma associated with COVID-19; different options for work; savings and debts; challenges with family housing and transport availability. Our results show that parents experience multiple effects of pediatric COVID-19 with regard to FHRQoL.

Incremental Value of FDG PET/CT in Aggressive High Grade B Cell lymphoma with TdT Expression

High-grade B-cell lymphoma, an aggressive form of Non-Hodgkin's Lymphoma, is known as a double or triple hit lymphoma based on the presence of MYC and BCL2 without or with BCL6 genetic rearrangements, respectively. It carries a poorer prognosis, compared to other variants of B-cell lymphoma, and its management also differs which requires more intensive chemotherapy in contrast to the routine regimen. Terminal deoxynucleotidyl transferase (TdT), a marker of immaturity is commonly expressed in B-cell lymphoblastic leukemia or lymphoma (B cell ALL) which is absent in mature forms of B-cell lymphoma. The TdT is expressed in high-grade B-cell lymphoma; therefore, it poses a classification and management dilemma, which should be accurately differentiated from B-cell ALL and mandates molecular analysis. Herein, we report a case of a 52-year-old female with biopsy reported as high-grade B-cell lymphoma with TdT expression. She was referred for Fluor-deoxyglucose (FDG) Positron Emission Tomography-Computed Tomography (PET/CT) scan for staging in the absence of molecular analysis for B-cell ALL. It was diagnosed as lymphoma on FDG PET/CT based on its characteristic findings of extensive extranodal involvement of multiple organs with no significant lymphadenopathy establishing the incremental value of FDG PET/CT scan, which helped the clinician to arrive at a conclusion.

Adjunctive treatment with probiotics partially alleviates symptoms and reduces inflammation in patients with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a functional bowel disorder. This study aimed to assess the effect of a probiotic product (containing Lactobacillus casei Zhang, Lactobacillus plantarum P-8, and Bifdobacterium animalis subsp. lactis V9) as an adjunct to a routine regimen in IBS management. Forty-five patients with IBS were randomized into the probiotic (n = 24) and control (n = 21) groups, receiving the routine regimen with or without probiotics for 28days, respectively. Serum and fecal samples were collected and analyzed. The IBS-symptom severity score (P < 0.01), serum levels of IL-6 (P < 0.01) and TNF-α (P < 0.001) were significantly lower in the probiotic group than the control group at day 28. The probiotic adjunctive treatment resulted in significant decreases in some bacterial genera that worsen IBS, such as Bacteroides (P < 0.01), Escherichia (P < 0.05), and Citrobacter (P < 0.05), significant decreases were also observed in some beneficial genera in the control group, including Bifidobacterium (P < 0.05), Eubacterium (P < 0.05), Dorea (P < 0.01), and Butyricicoccus (P < 0.05). Furthermore, significant correlations were found between some monitored parameters and compositional changes in the fecal microbiota, suggesting that the clinical improvement of IBS was likely associated with gut microbiota modulation. The enterotype analysis revealed that the initial fecal microbiota composition could influence clinical outcomes. The adjunctive use of probiotics with a routine regimen showed additional clinical effectiveness compared to the routine regimen alone in managing IBS. A pretreatment gut microbiome analysis might help tailor a personalized probiotic regimen to optimize treatment effects.

The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

BACKGROUND CONTEXTTranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction. PURPOSEThe primary aims were (1) to determine whether the multiple-dose regimen of TXA could reduce PBL and the postoperative transfusion rate, and (2) to compare the efficacy of oral administration with intravenous administration. The secondary aims were (3) to evaluate whether this regimen could alleviate inflammatory response, and (4) to assess the occurrence of drug-related side effects. STUDY DESIGNProspective, double-blinded, randomized controlled trial. PATIENT SAMPLEA total of 108 patients with AIS who underwent posterior scoliosis correction and spinal fusion (PSS) were enrolled in this study. OUTCOME MEASURESThe primary parameters were PBL and postoperative transfusion rate. Other parameters such as total blood loss (TBL), maximum hemoglobin (Hb) decrease, volume of drainage, inflammation markers (interleukin-6 [IL-6] and C-reactive protein [CRP]), and occurrence of complications were also collected and compared. Multiple regression analysis was used to examine the variables that affected PBL. METHODSPatients were randomized into three groups. All patients received intravenous TXA 50 mg/kg loading dose and 10 mg/kg/h maintenance dose during surgery. Group A received 1 g oral TXA at 4 hours, 10 hours, and 16 hours postoperatively; group B received 0.5 g intravenous TXA at 6 hours, 12 hours, and 18 hours postoperatively; group C received placebo. RESULTSThe mean PBL and postoperative transfusion rate in group A (957.8±378.9 mL, 13.89%) and B (980.3±491.8 mL, 11.11%) were significantly lower than those in group C [1,495.9±449.6 mL, mean differences=538.1 mL, 95% confidence interval (CI), 290.1–786.1 mL, p<0.001; 515.6 mL, 95% CI, 267.6–763.6 mL, p<.001]; (36.11%, p=.029, p=.013). Meanwhile, the mean TBL, maximum Hb decrease, and volume of drainage were also significantly lower in group A and B than in group C. IL-6 and CRP in group A and B were significantly lower than in group C from postoperative days 1 to 3. All these differences were not significant between groups A and B. No drug-related complications were observed in any patient. Multiple regression showed that the application of postoperative TXA and number of screws were significant parameters affecting PBL. CONCLUSIONSA multiple-dose regimen of TXA, either by oral or intravenous application, could be a safe and effective means of controlling PBL and decreasing the postoperative transfusion rate in patients with AIS who underwent scoliosis surgery. In addition, it could inhibit postoperative inflammatory response.

Effects of targeted back muscle exercises in reducing thoracic kyphosis in patients of hyperkyphosis

Increased thoracic kyphosis (hyperkyphosis) is well known entity especially in elderly population may be responsible for multiple morbidity and needs a non-pharmacological preventive strategy due to which muscle strength training has been routinely advised. Eighty patients were included in study and divided into two groups. One group received institutional and home-based exercise regimen and another group was administered the routine pharmacological regimen. Besides demographic variables, clinical (occiput to wall distance, pain, ODI score and spinal flexibility) and radiological parameters (Cobb’s angles of thoracic kyphosis, lumbar lordosis, and thoracic kyphosis in best erect posture) were assessed before and after the end of 3-month duration. The data between both the groups was comparable but the study group showed marked improvement at the end of study (mean difference of 1.8º) and significant improvement in clinical parameters of pain, ODI score, occiput to wall distance and spinal flexibility. The other values were insignificantly affected. We find that exercise regimen positively impacts and significantly improves the thoracic kyphosis, clinical and functional status of patients who have hyperkyphosis but undergo a targeted muscle training programme for back muscles.

Challenges in the management of concurrent diabetic ketoacidosis and Dengue hemorrhagic fever in a child

Diabetic ketoacidosis (DKA) is more commonly seen in children with type 1 diabetes and acute acidosis is usually precipitated by infections, trauma and surgery. Rarely, ketoacidosis can be precipitated by dengue often leading to management challenges in achieving haemodynamic stability. Occurrence of both conditions together warrant meticulous monitoring of fluid balance and control of blood glucose levels to manage both conditions optimally. Both type1 and type 2 diabetes upsurge the release of pro-inflammatory cytokines by various mechanisms and intensify the risk of plasma leakage. As prevalence of diabetes is lower in children compared with adults, diabetic ketoacidosis presenting with dengue is rare in the paediatric age group. We report a 14-year-old diagnosed child with type1 Diabetes mellitus who presented with dengue fever and subsequently developed dengue haemorrhagic fever and diabetic ketoacidosis concurrently. Both conditions were successfully managed with appropriate use of intravenous fluids and insulin. He had a complicated course with secondary bacterial infection needing intravenous antibiotics for 14 days. Ultimately he was discharged with his routine regimen of insulin and follow up was arranged at the endocrinological clinic.

Research Note: Increase of bad bacteria and decrease of good bacteria in the gut of layers with vs. without hepatic steatosis.

Fatty liver hemorrhagic syndrome (FLHS), usually occurring in hens in the late laying period, can lower egg yield and even cause death. Similar to nonalcoholic fatty liver disease in humans, FLHS may begin with simple hepatic steatosis. It is known that gut microbiota is important to the development of nonalcoholic fatty liver disease, but the relationship between FLHS and gut bacteria remains unclear. In this study, bacteria compositions in the ileum and cecum were determined by 16S rDNA sequencing analysis in the groups of hens with vs. without hepatic steatosis (average liver fat contents were 0.34 mmol/g protein or 2.6% vs. 0.84 mmol/g protein or 6.0%). These hens were in the 2 tails of the liver fat content distribution with each tail accounting for 10% of the test population containing 90 66-wk-old healthy Rhode Island Red laying hens raised under routine feeding regimen. The results showed that liver weight but not the weights of the body, heart and abdominal fat were significantly different between the groups. Moreover, bacterial diversity was not significantly different between the groups, but bacterial diversity in the cecum was higher than that in the ileum. Proteobacteria was the most dominant phylum in the ileum, whereas Proteobacteria, Firmicutes, and Bacteroidetes were the most dominant phyla in the cecum. Some bacteria were common to the ileum and cecum, but some were unique. Furthermore, some bacteria were significantly different in abundance between the groups, that is the group without hepatic steatosis had more bacteria inhibiting host energy absorption or benefiting intestinal health, whereas the group with hepatic steatosis had more conditionally pathogenic or harmful bacteria. In conclusion, hepatic steatosis in laying hens is associated with intestinal bacterial composition (bacterial abundance) but not bacterial diversity. The identified common and unique bacteria are related to the functional characteristics of the ileum and cecum. The decrease of beneficial bacteria and the increase of harmful bacteria in the intestine of laying hens may increase FLHS incidence by promoting hepatic steatosis.

Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis.

To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233mm (95% confidence interval: -1.065, 0.598; p=.351). Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.

Rotation advancement V-Y posterior thigh flap combined with a biceps femoris muscle flap for reconstruction of a recurrent ischial pressure sore in pediatric patients

Ischial pressure sores are mostly seen in wheelchair-bound pediatric patients, who are affected by a myelomeningocele, as a result of constant shearing force over the ischial region. The ischial sores are the most difficult to treat with high recurrence rates. Although there are various reconstructive modalities that are described for coverage of ischial pressure sores, there is still a long-term debate on an optimal method of reconstruction. Between April 2017 and June 2019, a total of 6 patients who were affected with a myelomeningocele anomalis were operated on for a total of 7 recurrent grade IV ischial ulcers. Data collection was done through analysis of medical records, which included the patients’ demography, operative details, and postoperative complications. A routine preoperative regimen including correction of the nutrition status and anemia should be ensured. We dissected a biceps femoris muscle turnover flap that obliterated the wound cavity and simultaneously applied a V-Y rotation advancement posterior thigh fasciocutaneous flap for coverage of ischial pressure sore surface. All flaps survived without early complications except for one case (14.2%) where a minor wound dehiscence had occurred and managed by secondary stitches. Among all 7 cases, only one (14.2%) had a recurrence 9 months after surgery, which required further debridement and advancement of the same flap. The mean follow-up period was 12.3 months (range, 4–24 months). Although there is still no ideal flap for closure of ischial pressure sores, the rotation advancement V-Y posterior thigh fasciocutaneous flap combined with a biceps femoris muscle turnover flap is considered a reliable reconstructive technique in pediatric patients. The present technique integrates the benefits of well-vascularized muscle tissue with a durable skin coverage that can be reused in cases of recurrence. Level of evidence: Level V, therapeutic study.

Effect of simplified Tai Chi exercise on relieving symptoms of patients with mild to moderate Parkinson's disease.

Tai Chi, a kind of physical exercise, may act as a non-pharmacologic approach to reducing the symptoms of Parkinson's disease. This study was conducted to investigate the effect of simplified Tai Chi training plus routine exercise on motor and non-motor symptoms in patients with mild to moderate Parkinson's disease in comparison with routine exercise regimen alone. Forty-one outpatients and inpatients with Parkinson's disease (PD) were randomized into Tai Chi group (N.=19) and routine exercise group as control group (N.=22) for 12 weeks. The Tai Chi group included both Tai Chi traning and routine exercise. Motor and non-motor functions were assessed. Motor function was evaluated by Unified Parkinson's Disease Rating Scale part III (UPDRS-III) and Berg Balance Scale (BBS). The non-motor symptoms like quality of life, sleep quality, depression and anxiety state, cognitive function were assessed by Parkinson's Disease Questionnaire-39 (PDQ-39), Parkinson's Disease Sleep Scale (PDSS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MOCA) respectively. After 12 weeks of intervention, participants in both Tai Chi and routine exercise groups gained effects in UPDRS-III, BBS, PDQ-39, PDSS and HAMD compared to the baseline. However, significant improvements between Tai Chi group and routine exercise group were only found in PDSS (P=0.029) and MoCA (P=0.024). Tai Chi training plus routine exercise might therefore be an ideal alternative non-pharmacological approach for the motor and non-motor symptoms of PD patients, and especially be more useful for the improvement of sleep quality and cognitive function in Parkinson's disease compared with routine exercise regimen alone.

Gabapentin for Peri-operative Pain Management for Office Uterine Aspiration: A Randomized Controlled Trial [10H

INTRODUCTION: Gabapentin, used to treat neuropathic and chronic pain, has also been used to reduce post-surgical pain in a variety of clinical settings. We investigated if the addition of gabapentin to the routine oral sedation regimen would reduce peri-operative pain from uterine aspiration. METHODS: IRB approval and informed consent were obtained. We enrolled patients seeking first trimester uterine aspiration with oral sedation in a randomized double-blind placebo-controlled trial to receive placebo or 600 mg of oral gabapentin in addition to oral sedation and paracervical block. Our primary outcome was pain 5-minutes after procedure measured on a VAS (100 mm) pain scale. Secondary outcomes measured included pain at a variety of time points, post-operative pain medication use, anxiety and nausea. This study was powered to detect a 16 mm difference in pain. To assess the effect of gabapentin at the 5-minute post-op assessment, we fit a linear regression controlling for baseline pain. RESULTS: 96 patients were randomized (95 completed study protocol). Patients receiving gabapentin reported similar pain scores compared to placebo at the 5-minute post-op assessment (p = 0.56). Anxiety measures were similar between groups at several time points. Gabapentin was well-tolerated and side effects were similar between groups. 15% of women receiving gabapentin versus 31% receiving placebo recorded using narcotic pain medication within 24 hours of the procedure (p = 0.06). CONCLUSION: Gabapentin did not have a significant effect on the 5-minute post-operative pain measurement or anxiety. The trend toward decreased opioid usage in the post-operative period amongst the gabapentin users warrants future investigation.

Is There a Preferred Mode of Exercise for Cognition Enhancement in Older Age?-A Narrative Review.

The aim of this review is to examine the moderating effect of the mode of exercise on the exercise-cognition relationship. Is one mode of exercise more efficient in enhancing cognition than the other? For example, is aerobic exercise preferable over balance training? Based on official guidelines for old age, exercise modes include aerobic activity, strength (resistance) training, flexibility, balance, and coordination. In relation to cognition, these exercise modes are further divided into two categories: physical training—aerobic and strength, and motor training—balance, coordination, and flexibility. The physical training activities are repetitive and automatic in nature, and require high metabolic energy and relatively low neuromuscular effort. The motor activities involve high neuromuscular demands and relatively low metabolic demands. In addition, there are specific movement skills that require more neuromuscular effort (e.g., Tai Chi), and sometimes also greater metabolic demands (e.g., tennis). Selected studies examining the effect of various modes of exercise on cognition contend that both training categories affect neuroplasticity, and consequently cognitive functioning. However, there are two main differences between them: (1) Physical training affects cognition via improvement in cardiovascular fitness, whereas motor training affects cognition directly; (2) Physical training affects neuroplasticity and cognition in a global manner, while motor training is task-specific in increasing brain neuroplasticity and in affecting cognition. Examining the underpinnings of these pathways reveals that there is a difference in the underlying forces behind the two training categories. In the physical training category, it is the intensity of training that enhances neuroplasticity and consequently improves cognition, while in the motor activities it is the task complexity that increases neuroplasticity, which improves cognition. Dual-task training, which includes cognitive demands in addition to physical or motor activity, has proven more effective in improving cognitive functioning than a single task. The implications are that if all training components traditionally recommended by official bodies—physical as well as motor training—are efficient in enhancing cognition, then we merely have to emphasize the inclusion of all exercise modes in our routine exercise regimen for physical as well as cognitive health in advanced age.

Effects of middle-upper posture Baduanjin on anxiety, depression and quality of life among patients with ulcerative colitis

Objective To explore the effects of middle-upper posture Baduanjin on anxiety, depression and quality of life among patients with ulcerative colitis, so as to provide experience and a reference for clinical nurses. Methods From February to October 2017, we selected 60 ulcerative colitis inpatients of Gastroenterology Department in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine as subjects by convenience sampling. All of the patients were divided into control group and observation group with the random number table, 30 cases in each group. Control group received routine therapeutic regimen and health guidance. On this basis of that in control group, observation group carried out middle-upper posture Baduanjin one time a day for three months. The Hospital Anxiety and Depression Scale (HADS) and Inflammatory Bowel Disease Questionnaire (IBDQ) were used to compare the scores of anxiety, depression and quality of life of patients between two groups before and after intervention. The SPSS 19.0 was used to statistical analysis. Results Before intervention, the scores of anxiety and depression of patients in control group were (11.06±1.77) and (11.34±1.49) respectively with no statistical difference compared with those in observation group (t=0.175, 0.183; P>0.05) . One month and three months after intervention, the scores of anxiety of observation group were (8.06±1.35) and (6.01±1.08) lower than those of control group [ (9.21±1.43) and (8.28±1.97) ]; the scores of depression of observation group were (8.19±1.27) and (6.15±1.14) lower than those of control group [ (9.85±1.33) and (8.59±1.61) ]; the differences were all statistical (t=3.203, 5.534, 4.944, 6.775; P 0.05) . After intervention, the total score of life quality in observation group was (152.91±31.71) statistically higher than that (121.21±30.26) in control group (t=3.961, P<0.01) . Conclusions The middle-upper posture Baduanjin can improve the anxiety, depression and quality of life among patients with ulcerative colitis being worth to be widely used in clinical application. Key words: Colitis, ulcerative; Quality of life; Anxiety; Depression; Middle-upper posture; Baduanjin

Effectiveness and safety of different schemes of perioperative prophylaxis withheparins in spine surgery

To study of effectiveness and safety of different schemes of perioperative prophylaxis against thromboembolism with heparins 36 patients who has been undergone spinal surgery under general anaesthesia were divided into three equal groups. Heparin, enoxaparin, and bemiparine were administrated to patients of h-group, e-group, and b-group, respectively, in routine regimen. Large ecchymosis, thromboembolic events, and bleeding were registered for first 5 postoperative days. Only the former has shown statistically significant differences between hand b-groups (p=0.01). In addition, emergence of large ecchymosis was higher in e-group compared with b-group (p=0.047). Thus, our data have suggested effectiveness and safety of different schemes of perioperative prophylaxis with heparins in spine surgery.

GLOBIAD categorisation tool for monitoring of Incontinence-associated dermatitis

Objective — to determine the categories of GLOBIAD in patients with incontinence­associated dermatitis (IAD) and to evaluate the effectiveness of topical use of camphor racemic solution in concentration of 0.1 g in 1 ml of sunflower oil.Materials and methods. Camphor racemic solution in concentration 0.1 g in 1 ml of sunflower oil was used in 104 patients with IAD to clean and protect the skin from urine and/or stool. Category evaluation of IAD wasmade by GLOBIAD categorisation tool. In 30 patients of the control group, routine skin care products were used. The comparison was performed before the start of treatment and in one month of treatment.Results and discussion. Topical application of the medication under study in patients with IAD resulted in significant decrease of the number of patients with 2B category — from 30 (28.8 %) to 16 (15.4 %) persons (χ2 = 22.1; p < 0.001) and in increase of the number of patients with 1A category — from 29 (27.9 %) to 52 (50.0 %) patients (χ2 = 21.0; p < 0.001). These results show similar efficacy of the test drug and of routine care regimen in both mild IAD (category 1A) and severe IAD with infection complications (category 2B).Conclusions. Topical application of camphor racemic solution to provide skin care stages in patients with IAD contributed to an improvement in the course of the disease by reducing the number of cases of patients with category 2B GLOBIAD and increasing the number of patients with category 1A, which reflected healing of erosion and eradication of concomitant local infection.

Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma

Transarterial chemoembolization (TACE) is the primary palliative treatment for patients with unresectable hepatocellular carcinoma (HCC). However, it is often accompanied by postoperative pain which hinder patient recovery. This study was to examine whether preemptive parecoxib and sufentanil-based patient controlled analgesia (PCA) could improve the pain management in patients receiving TACE for inoperable HCC. From June to December 2016, 84 HCC patients undergoing TACE procedure were enrolled. Because of the willingness of the individuals, it is difficult to randomize the patients to different groups. We matched the patients' age, gender and pain scores, and divided the patients into the multimodal group (n = 42) and control group (n = 42). Patients in the multimodal group received 40 mg of parecoxib, 30 min before TACE, followed by 48 h of sufentanil-based PCA. Patients in the control group received a routine analgesic regimen, i.e., 5 mg of dezocine during operation, and 100 mg of tramadol or equivalent intravenous opioid according to patient's complaints and pain intensity. Postoperative pain intensity, percentage of patients as per the pain category, adverse reaction, duration of hospital stay, cost-effectiveness, and patient's satisfaction were all taken into consideration when evaluated. Compared to the control group, the visual analogue scale scores for pain intensity was significantly lower at 2, 4, 6, and 12 h (all P < 0.05) in the multimodal group and a noticeably lower prevalence of post-operative nausea and vomiting in the multimodal group (31.0% vs. 59.5%). Patient's satisfaction in the multimodal group was also significantly higher than that in the control group (95.2% vs. 69.0%). No significant difference was observed in the duration of hospital stay between the two groups. Preemptive parecoxib and sufentanil-based multimodal analgesia regime is a safe, efficient and cost-effective regimen for postoperative pain control in HCC patients undergoing TACE.

Pharmacokinetics of cefuroxime in infants and neonates undergoing cardiac surgery.

Very little data exist regarding the effect of cardiopulmonary bypass (CPB) on cefuroxime (CXM) pharmacokinetics in children less than one year of age. 50mgkg-1 CXM i.v. after induction were followed by 75mgkg-1 into the CPB circuit. In 42 patients undergoing cardiac surgery, 15-20 samples were obtained between 5 and 360min after the first dose. Total CXM concentrations were measured by high-performance liquid chromatography and a pharmacokinetic/pharmacodynamic (PK/PD) modelling was performed. Using a fixed protein binding of 15.6% for CXM, peak plasma concentrations of unbound CXM were 229 ± 52μgml-1 after the first bolus and 341 ± 86μgml-1 on CPB. Nadir concentrations before CPB were 69 ± 20μgml-1 and six hours later decreased to 41 ± 19μgml-1 with and 24 ± 14μgml-1 without CPB. A two-compartment model was fitted with the main covariates body weight, CPB and postmenstrual age (PMA). PK parameters were as follows: systemic clearance, 5.15 [95% CI 4.5-5.8]lh-1 ; central volume of distribution, 11.25 [9.41-13.09]l; intercompartmental clearance, 18.19 [14.79-21.58]lh-1 ; and peripheral volume, 17.07 [15.7-18.5] L. ƒT>MIC of 32μgml-1 for an 8-h time period was between 70 and 100% (2.5-10kg BW). According to our simulation, 25mgml-1 CXM as a primary bolus and into the prime plus a 5mgkg-1 h-1 infusion maintain CXM concentrations continuously above 32μgml-1 . The routine dosing regimen provided was sufficient for prophylaxis, but continuous dosing can provide a higher percentage of ƒT>MIC.